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April 30, 1999
.in
.sp
.ce 
JZR HOME CARE
.sp 3
GENERAL
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.sp
Enter date and name in ledger at start of shift.
During shift, record actions and observations in ledger,
particularly any observations of unusual physical or mental behavior.
Please note medicines given, food, toilet, etc.
These entries should continue the record at its current place in the ledger,
somewhere after page ???.
.sp
In Table at end of ledger, record vital signs when measured, 
record size of meals eaten,
check off exercises when done, bedding changes, bowel movements....
NB: we are in the process of getting a blood O\d2\u saturation meter,
so this 5th vital sign must wait on its measurment.
.sp
Wash your hands immediately upon arriving at apartment.
Wash your hands before preparing or touching food.
Wash your hands after assisting at toilet, etc.
.sp
Wash JZR hands before and after meals, and after toilet.
.sp
If there is any evidence of illness or malfunction, err on the side of
caution and alert Forum nurse (telno=???-????).
.sp
All movements of JZR about apartment, e.g., to toilet, 
during walking exercise, etc., should be with gait belt in place and held.
.sp
Call the Forum dining room just before 11:00AM and 3:00PM, 
as detailed under MEALS, 
which section also gives other information about food.
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.SK
EARLY AM, no later than 9:30 AM:
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.sp
Wakeup.
.sp
Toilet.  Give warm wash cloth and some peri cleaner so JZR can wash.
.sp
Brushing teeth.  Have a fresh glass of water in black cup on bathroom sink.
.sp
Check hearing aid for wax (only do this after being tutored by JAR).
Put in hearing aid, activated by pushing battery cap closed. 
Keep all hearing aid equipment in one place (currently, on shelf in closet).
.sp
Breakfast, not necessarily large but needed with medicines.
.sp
Medicines, from slot of box corresponding to day.
.sp
Vital signs, recorded in Table at end of ledger:
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Weight, pulse, temperature, blood pressure, oxygenation.
Methods of measurement should be consistent from day-to-day and 
consistent with methods of other care givers.
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.sp
Dress JZR, or allow to return to bed if wanted. 
Assist in her grooming.
.sp
Make bed, with clean linen if linen soiled or if 4 days since last change
of linen (see record at end of ledger for date of last change).
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.sp 2
NIGHT, no later than 9:00PM
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.sp
Dress JZR for bed.
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Raise side bars when in bed.
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Be sure intercom working.
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.SK
ACTIVITIES
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.sp
JZR is a generally private person and likes to be alone in room.
Nevertheless, please do check with her periodically to see if something
might be done for her.
.sp
Strongly encourage JZR to read newspaper (WSJ to start soon) and to
work crossword puzzles.
.sp
Please arrange that she watch TV, at least her favorite programs:
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Any baseball, but especially the Mets.
.br
Daily, M-F:
News on ABC, CH9, at 6:00PM, 
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followed by Wheel of Fortune at 6:30PM.
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.br
Daily, M-F:
News Hour on PBS, CH6, at 7:00PM
.br
If in doubt, try NBC, CH4.
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.sp 2
EXERCISE
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.sp
Allow JZR to rest during an exercise.
.sp
Walk 50 feet per day, using walker, with gait belt security.
One long walk or two shorter walks.
.sp
Upper body and lower body exercises, once per day, sets of 3 arm and 3 leg
exercises as on accompanying sheet.
.sp
A physical therapist from the Forum also will work with JZR.
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.sp 2
TOILET
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.sp
Toilet during day: 
help JZR to bathroom, leave her alone but remain close by, ask if
finished, supply wash rag for hands (fresh wash rag each AM).
.sp
Toilet during night:
watch for JZR call on intercom, help to use commode beside bed, leave room
until called back, then help to bed.
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.sp 2
DRESS and GROOMING
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.sp
JZR needs assistance dressing.  Please ask her about her wishes:
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	Nightgown and bed jacket or robe.
.br
	A dress with appropriate underthings, etc.
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.sp
JZR can groom herself, except she may welcome assistance in brushing hair.
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.sp 2
BATH or SHOWER
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.sp
Mondays and Thursdays in the morning
(at least 2 times per week), in shower off study with chair and spray head.
JZR can bathe herself, with minimal assistance.
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.sp 2
MEDICINES
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.sp
Fill slots in medicine box when needed, from prescription bottles. This
should be done by two persons, to ensure accuracy.
.sp
When a prescription is low, reorder from Jeff at Wilmot Pharmacy.
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.sp 2
TRANSPORT
.sp
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For transport to physician's office, etc.:
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a. Call JAR
.br
b. Arrange with Forum main desk (???-????) for transport with their car.
.br
c. You should find out what times are free for JAR or Forum car before making 
arrangements with physician, or at least tell physician's office that the
appointment may have to be adjusted.
.br
d. DO NOT USE Rural Metro.
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.sp 2
TELEPHONE NUMBERS
.sp
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.sp 2
.SK
MEALS and WATER
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.sp
During recent stay in hospitals, JZR lost 20 lbs.  She needs to eat,
but she is a light eater.
She may say she does not want to eat.  But at mealtime, 
put out food anyway, and encourage her to eat.  
.sp
Record in ledger food prepared for each meal. 
This helps others determine what JZR likes to eat.
.sp
Record in Table at end of ledger the amount (S=small, M=average, L=large)
of food eaten at a meal.  Include snacks in nearest-time meal.
.sp
Typical meals given at end of this set of notes.
.sp
Consult JZR about food for next meal.
Try to order or prepare food she likes.  
See list near end of ledger (page ????).
When appropriate, add new foods to this list 
.sp
Call the Forum dining room (319-4319) 
by 11:00AM to arrange for lunch and by 3:00PM to
arrange for dinner.  Ask JZR for her preferences from menu.  If no current
menu, get from front desk.
If soup is offered, please order it, for both lunch and dinner.
.sp
Reheat (microwave, oven, etc.) any foods brought up from Forum kitchen.
.sp
JZR very much likes home-cooked food.  Please do cook when possible.
Write shopping needs on list.
.sp
Water is in dispenser in laundry room. 
Have a glass by chair or bed at all times.
Encourage drinking water.  No need to record input and output at this time.
.sp
Canned foods and some nonperishable boxed foods are in entry hall closet
opposite from kitchen.  Most boxed foods (crackers, etc.) are in cupboards
above and below counter, to the right of sink.  Spices are in cupboard above
sink.
.sp
Dishes, pots and utensils
are in cupboards to left of sink, and in drawers.
.sp
Breakfast when wakes, no later than 9:30AM.
.sp
Lunch when asks, or no later than 1:00PM.
.sp
Dinner when asks, or no later than 8:00PM.
.sp
Snacks on request ok.
.sp
Encourage drinking a can of Ensure, especially if food intake low.
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.sp 2
.SK
HOUSEKEEPING
.sp
.in +.5i
BED and BATH
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Each morning, clean wash cloth on bathroom sink.
.sp
Each morning, make bed when JZR gets up.
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If bedding soiled, change it.
.sp
Change bedding after 4 days. See ledger record to find time of last
change.
.sp
Record change of bedding in Table at end of ledger.
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.sp
GARBAGE
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Wet garbage from food preparation is under sink in kitchen.
Each morning before 9:00AM,
put this plastic bag and plastic bag with other garbage outside front
door.
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.sp
CLEANING
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Each morning except weekends, Forum personnel do a quick cleaning.
This is not enough for the usage the apartment has.
.sp
Thus by the end of each shift:
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Wash and dry and put away all dishs and utensils.
.sp
Wipe down with soapy cloth the kitchen surfaces, and then wipe dry.
.sp
Wipe down with soapy cloth the bathroom surfaces, and then wipe dry.
.sp
Straighten up the refrigerator, and whatever else seems disorganized.
Cover with saran wrap any food stored in refrigerator and not in container.
.sp
If there is a mess (e.g., urine on rug, food spill on rug), clean it up,
scrubbing rug with soap, then rinsing with water.
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.sp 
LAUNDRY
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Do laundry as required using washer and dryer in laundry room.
.sp
Send out dry cleaning, via Forum personnel.
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.sp 
SHOPPING
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This will be done by Vicki Carroll, on Tuesday afternoon, from a list
prepared by care givers during week.  Please do add whatever is needed to
this list.  List should be posted on refrigerator.
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.SK
TYPICAL MEALS
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.sp
Generally JZR will drink tea with a meal.
.sp
Breakfast
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Banana, half or whole, essentially always eaten, along with such as the
following:
.sp
Orange juice, and 1 piece rye toast or 1 waffle cut up.
.sp
1 egg, 1 piece bacon, and 1 piece toast.
.sp
Sweet roll.
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.sp
Lunch
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A sandwich, ham on rye, or swiss cheese on rye, or both on rye,
with mustard.
.sp
Cream cheese and sliced black olives sandwich.
.sp
Soup and crackers.
.sp
Both soup and 1/2 sandwich.
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.sp
Dinner
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Wider range of possibilities are accepted.
See old notes for thoughts.
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.sp
.SK
.ce
SUMMARY
.sp 2
Daily, before 9:30AM:
.in +.5i
Wakeup
.br
Vital signs
.br
Hearing aid
.br
Breakfast
.br
Medicines
.br
Dress and Groom
.br
Make bed (change bedding)
.br
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.sp
Daily, before 9:00PM:
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Dress for bed
.br
Raise bars on bed
.br
Check intercom
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.sp
Monday and Thursday Mornings:
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Bath or Shower
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.sp
JZR Activities, Daily:
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Exercise
.br
Reading and TV
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.sp
Housekeeping, Daily:
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Before 9:00AM, garbage out
.br
At end of each shift: clean up kitchen, bath, refrig, any mess on rugs, etc.
.br
Laundry and Dry Cleaning, as needed
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.sp
Meals, Daily:
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Before 11:00AM, call Forum DR to order lunch.
.br
Before 3:00AM, call Forum DR to order dinner.
.br
Always put out food for B, L and D, even if refused by JZR.
.br
Encourage drinking of Ensure.
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